Clarithromycin Therapy for Mycobacterium avium Complex Bacteremia

Chaisson and colleagues [1] found a good bacteremia-decreasing effect of all dosage schedules used. An early survival advantage was seen with the 500-mg twice-daily dose compared with higher doses. According to the authors, this difference was not a result of more severely ill patients being assigned to receive the higher doses. The authors also contend that the poor survival of patients receiving the 2000-mg twice-daily dose may have been related to the intolerance to clarithromycin of patients assigned to this dose. There was no difference in the number of dose-limiting reactions between patients assigned to the 500-mg and 1000-mg twice-daily dose, and the authors concluded that the survival advantage with the 500-mg twice-daily dose was not fully understood. They recommended use of the 500-mg twice-daily dose in the initial treatment of Mycobacterium avium complex bacteremia.